Christie's Extreme Rhetoric Masks Moderate Position on ACA

Gov. Chris Christie yesterday denounced the original Medicaid requirements in President Obama’s healthcare law as “extortion,” but once again staked out a more moderate position than most other GOP governors by refusing to rule out participation in the two of the law's most controversial programs.

Christie grabbed national headlines with Monday's “extortion” remark, made at the Brookings Institution, a liberal-leaning think tank in Washington, D.C. But it is his continued openness to an optional federally funded expansion of New Jersey’s Medicaid rolls and to participation in the online healthcare exchanges expected to sell coverage to the uninsured that is most significant for New Jerseyans.

It is unclear how Christie’s nuanced position on Obama’s healthcare law plays with conservative Republicans clamoring for presidential nominee Mitt Romney to choose Christie as his vice presidential running mate or as the keynote speaker at the GOP National Convention in Tampa next month.

The contrast with the nation’s “red meat” conservatives could not be clearer, however.

Wait and See

On the same day that Texas Governor Rick Perry declared "I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government,” Christie said he would take a “wait and see” approach to whether New Jersey should take advantage of new federal funding to expand Medicaid eligibility to up to 450,000 more state residents.

While Christie declined to join Perry and the Republican governors of Florida, Mississippi, Louisiana, and South Carolina in ruling out Medicaid expansion and healthcare exchanges, the popular Republican governor’s use of the word “extortion” seemed likely to overshadow his moderate position where it counts – on YouTube, where Christie’s 5 million visitors have made him a national star.

“I’m really glad that a majority of the Supreme Court still supports the proposition -- as a former prosecutor -- that extortion is still illegal in the country, even when done by the President of the United States,” Christie said during the question-and-answer session that followed his 40-minute address to the Brookings Institution on “Restoring Fiscal Integrity and Accountability.”

Christie insisted that “ObamaCare on Medicaid was extortion -- you expand the program to where we tell you and if you don’t, we’re taking all the rest of your money away. Well, that’s extortion.”

Nevertheless, Christie said he would probably not decide until next January whether New Jersey should expand the state’s Medicaid rolls by up to 45 percent to cover another 450,000 poor and disabled residents. That's in addition to the 1 million who are already covered by the federal health program started in the 1960s along with Medicare as a cornerstone of Democratic President Lyndon B. Johnson’s “Great Society.”

While the federal government provides only 50 percent of the cost of Medicaid for current recipients, the Obama expansion would cover the full costs of the program for the new recipients for the first two years. After that, it would reimburse the state at 90 percent for those new enrollees.

Christie noted that the new law does not kick in until next July 1, 2013, and said the state would have to analyze the budgetary impact in Fiscal Years 2014 and 2015.

“It seems to me that for a place like New Jersey, we have the second most expensive Medicaid program in the country, behind New York,” Christie said. “And so our question is going to be, how much more do we really need to expand our program because we have some of the most generous benefits already.” Determining the effect of changes to the program is difficult, given that New Jersey's matches and formulas are different from other states.

Creating an Exchange

Christie added that New Jersey would most likely make a decision by early 2013 on whether to set up its own “state-run exchange or . . . let the federal government run the exchange” to market health insurance plans to the uninsured. Actually, ACA says that states have until January 1, 2013 to demonstrate they are capable of running their own exchanges. If they are not, the federal government will step in and set up and run the online marketplaces.

He emphasized that his policy team already has begun its analysis, and that the decision would be based on two criteria: “what makes it better for the people of our state, and what’s the most efficient and effective way to do it from a cost perspective.”

Christie’s positions on Medicaid expansion and the healthcare exchange are not in line with the strident positions taken by Republican conservatives like Rep. Scott Garrett (R-NJ) -- one of 83 GOP House and Senate members who urged the nation’s governors to refuse to go along with implementation of the state healthcare exchanges included in Obama’s healthcare plan.

Yesterday, Perry, the conservative Texas governor whose short-lived bid for the Republican presidential nomination ended in January, announced that he was rejecting both the Medicaid expansion and the healthcare exchange.

“Neither a ‘state’ exchange nor the expansion of Medicaid under the Orwellian-named PPACA would result in better ‘patient protection’ or in more ‘affordable care,’” Perry wrote in informing U.S. Health and Human Services Secretary Kathleen Sebelius that Texas wanted no part of Obama’s Patient Protection and Affordable Care Act.

The Republican Centerpiece

While many Republican conservatives want to make the ACA the centerpiece of their campaigns, it could be a difficult strategy to pursue because Romney, as Massachusetts governor, passed a statewide health insurance expansion program that served as a forerunner to Obama’s federal program.

Romney senior adviser Eric Fehrnstrom tried to differentiate Romney’s plan from Obama’s by insisting that Romney’s contained a “penalty” for those who failed to purchase health insurance, while Obama’s plan was a “tax.” This echoed the argument made by the federal government’s lawyers in the U.S. Supreme Court in defending the power of Congress and the president to impose such a mandate. The nation’s highest court agreed, upholding the constitutionality of the plan by a narrow 5-4 margin.

Christie, an early Romney supporter and one of his most active surrogate speakers, also took a different tack from Romney’s spokesman last week in asserting that the individual mandate requiring citizens to buy health insurance is both a tax and a penalty.

"I've thought all along that it was a tax," Christie said in an appearance on Fox, the network of choice for Republican conservatives. "And I don't think it's exclusively a tax or a penalty -- it's both."

It was a question at the Brookings Institution about whether he still regarded the individual mandate as a tax that prompted Christie’s attack on Obama for attempted “extortion.”

Now that the rest of the healthcare law has been upheld by the U.S. Supreme Court, however, Christie is going to take his time deciding whether Medicaid expansion and health care exchanges deserve his quiet support or his famous wrath.